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CP3 Knowledge Resits > Medicine/neuro > Flashcards

Medicine/neuro Flashcards

1
Q

Cerebellar signs

A
  • (Truncal ataxia)
  • Broad based ataxic gait
  • Rhomberg positive
  • Nystagmus
  • (Saccades)
  • Past pointing
  • Dysphonia/Sticato(british constitution)
  • Dysdiadochokinesia
  • Rebound phenonemon
  • (Pronator drift)
  • Hyperreflexia
  • Hypotonia
  • Heel to shin coordination impairement
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2
Q

Brief causes of cerebellar disease

A
  • MS
  • Alcohol
  • Vascular
  • Inherited
  • Space occupying lesion
    (MAVIS)
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3
Q

Summary of TACI, PACI, Lacunar, POCI (Full NCs under Medicine/Stroke)

A
  • TACI
  • Hemiplegia
  • Homonymous hemianopia
  • Higher corticol dysfunction
    PACI
  • 2 of 3
  • Lacunar
  • Hemi-motor or hemi-sensory deficit only
  • POCI
  • Visual fields affected
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4
Q

Define:hemiparesthesia,Hemiparesis and hemiplegia

A

Hemiparesthesia - altered sensation on one half of the bodyHemiparesis - weakness on one half of the bodyHemiplegia - paralysis of one half of the body

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5
Q

Explaining MS to a patient

A
  • Multiple sclerosis (MS) is a condition that can affect the brain and/or spinal cord, causing a wide range of potential symptoms, including problems with vision, arm or leg movement, sensation or balance.
  • Autoimmune conditionwhere the body attacks the coating of nerves
  • It’s a lifelong condition that can sometimes cause serious disability, although it can occasionally be mild.
  • In many cases, it’s possible to treat symptoms. Average life expectancy is slightly reduced for people with MS.
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6
Q

Risk factors for MS

A
  • 20-30 years old
  • Female
  • FHx
  • Infections such as EBV
  • Caucasian
  • Autoimmune PMHx e.g. hypothyroid, DM I etc.
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7
Q

Common presentations of MS

A
  • double or blurred vision
  • numbness, weakness in one or two extremities
  • instability in walking
  • tremor
  • problems with bladder control
  • heat intolerance
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8
Q

Types and brief definition

A

Relapsing remitting 80% of cases Episodes/attacks of MS lasting days or weeks that may fully recover or leave patient with permanent problems May turn into 2ary progressive Primary progressive 10% of cases Slow progression of sx without remission, though may have ‘stable’ phases 2ary progressive Half of people with relapsing and remiting will develop this Starts as relapsing and remiting then turns into a progressive picture

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9
Q

Investigations of suspected MS

A
  • Refer to neuro
  • 2 attacks - soft
  • Full neuro exam
  • MRI
  • Evoked potential test (EEG with eye test)
  • Lumber puncture looking for auto-immune antibodies
  • Bloods - to rule out other things
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10
Q

Differentials of MS

A
  • Stroke
  • Toxins
  • B-12 deficiency
  • Space occuping lesion
  • Other inflammatory disorders like lupus
  • HIV
  • Vasculitis
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11
Q

Treatment of MS

A
  • LEMONS (lifestyle, education, monitor for complications, nutrition) Treat relapses
  • Steriods (pred) reduce length
  • Baclofen for mm spasms Prevent relapses
  • Disease modifying drugs e.g. interferon beta, alemtuzumab Treat symptoms
  • MDT
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12
Q

Circle of willis

A
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13
Q

Bells palsy features, causes, treatment

A

Bell’s Palsy (LMN) - temporary palsy of facial nnFeatures - same side as lesion
* Unilateral facial weakness incl forehead
* Bell’s sign (eye rolls upward when trying to close eyelids)
Causes
* Herpes (Ramsay-hunt syndrome vesicles in ear)
* HIV
* Sarciod
* EBV
* Lymes disease
Treatment
* Eye protection - drops, patch
* Prednisone

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14
Q

Other LMN CN7 palsy causes and associated features

A

Acoustic neuroma - CN5,6+8involvementParotid tumour/ectomy - parotid lump/scarCholesteatoma - CN8 involvementAll features will be same side as lesion

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15
Q

UMN CN7 palsy features, causes and associated sx

A

Features
* Forhead sparing
* Opposite side to lesion
Causes
* Stroke - hemianopia, hemiparasis/stesia, high cortical dysfunction
* MS - multiple neuro foci e.g. vision problems, sensory and motor issues, bladder problems

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16
Q

Horners syndrome causes, sx, investigation

A 
Horners syndrome - Damage to sympathetic chain that supplies faceCauses	
* Tumours (thyroid, brain, pancoast)	
* MS	
* Trauma e.g. thyriodectomy	
* Cervical rib	
* Migraine	
* Carotid aneursym/dissection	
* Otitis media
Features - all on sameside as lesion	
* Ptosis	
* Anhydrosis (no sweating)	
* Miosis (contracted pupil)
Diagnosis	
* No reaction to cocaine eye drops, normally dilates
Investigation	Identify cause			
* MRI - Ca		
* Carotid USS - carotid pathology		
* CXR - pancoast
17
Q

Motor neurone disease: presenting sx/ RF

A 
MN disease - degeneration of motor neuronesPresenting sx	
* Limb weakness	
* Slurred speech	
* Weak grip	
* MM cramps and fasiculations	
* Wgt loss	
* Laughing and crying at inappropriate times	
* FHx	
* Age <70
18
Q

Parkinsons: Triad

A

Parkinsons - Death of dopinergic nerves in basal gangliaTriad (assymetrical)

  • Bradykinesia
  • Resting tremor
  • Cog wheel rigidity
19
Q

PD B symptoms

A

ASSYMETRICAL

  • Shuffling gait, limited arm swing, hesitation when starting and turning
  • Expressionless face
  • Slurred/slow/monotonous speech
  • Positive glabellar tap
  • Anosmia
  • Balance problems
  • Urinary/sexual dysfunction
  • Visual problems
  • Swallowing issues
  • Insomnia
  • Micrographia
20
Q

PD investigations and treatment

A 
Investigations	
* Full neuro exam	
* Refer to specialist
Treatment	
* MDT	
* LEMON	
* L-Dopa
21
Q

PD plus syndromes and associated features

A
  • Multi-system-atrophy - Low BP/postural hypotension
  • Progressive supranuclear palsy (PSP) - Palsy of eye movement
  • Corticobasal degeneration - apraxia, acalculia, myoclonus
  • Lewy body dementia - dementia
22
Q

Peripheral neuropathy definition and examples

A

Peripheral neuropathy - damage to nns of peripheral nervous systemExamples

  • Foot drop - common peroneal nn
  • Diabetic - polyneuropathy
  • Carpal tunnel syndrome - median nn
  • Bell’s palsy - CN7
23
Q

Myopathy definition and examples

A

Myopathy - disease in which mm fibres don’t work properlyExamples

  • dermatomyositis - autoimmune condition that attacks skin and mm
  • polymyositis - inflammation of mm
  • myositis ossificans - mm turns into bone when injured
24
Q

Spinal cord stenosis: signs and sx, investigation, causes, treatment

A 
Spinal cord stenosis - narrowing of spinal canal leading to pressure on spinal cord and nn roots. Can lead to cauda equinaSymptoms	
* Posterior back and leg (both) pain can also be: numbess, weakness, stiffness or parasthesia (pins and needles)	
* Variable exercise tolerance day to day	
* Sx relieved by bending forward or sitting down (shopping trolley)
Signs	
* Men	
* Lumbar	
* Variable hyporeflexia	
* Normal strength and sensation
Investigation	
* CT
Causes	
* OA	
* Disc degeneration	
* Pagets disease	
* Thick spinal ligaments	
* Previous spinal trauma
Treatment	
* Physio - exercise bike	
* Surgery if bad - laminectomy	
* Analgesia
25
Q

Cauda equina: signs and symptoms, causes, investigation, treatment

A 
Cauda equina - compression of cauda equina L2 downSigns	
* Leg weakness	
* Reduced anal tone and sensation	
* Urine retention check with catheter
Symptoms	
* Saddly anaesthesia	
* Severe lower back pain	
* Urinary and bowel problems - retention/incontinence of either	
* Leg pain/weakness/parasthesia bilateral
Causes	
* Central disc herniation	
* Spondylosis	
* Spinal stenosis	
* Tumour	
* Trauma	
* Infection
Investigation	
* Emergency MRI of lumbar spine
Treatment	
* Admit	
* Decompress - surgery	
* Analgesia
26
Q

Disc herniation - signs and symptoms, causes, investigation, treatment

A 
Disc herniation - interverterbral disc prolapse leading to pressure on nerve rootsSigns	
* Decreased power, sensation, reflexes
Symptoms	
* Lumbar	
* Severe back pain, made worse by moving, bending forward, coughing, sitting, lateral flexion	
* Radiculopathy	
* Parastesia	
* Weakness	
* Leg pain	
* Back mm spasm
Causes	
* Age/degeneration	
* Lifting excess wgt	
* Excessive excerise	
* Obesity
Investigation	
* Spurlings, femoral nn stretch, straight leg raise	
* PNS
Treatment	
* Analgesia	
* Mm relaxants	
* TCA	
* Gabapentin	
* Rest
27
Q

Cervical myelopathy: signs, symptoms, causes, investigation, treatment

A 
Cervicalmyelopathy - compression of cervical spinal cordSigns	
* Weakness and wasting of hand mm	
* Hypereflexia	
* Clonus/Hofmans/Babinskis	
* Normal sensation
Symptoms	
* Progressive	
* Weakness	
* Arm, neck and leg pain	
* Problems with fine motor
Causes	
* Cord compression (tumour, disc herniation etc.)	
* Ischaemia from vascular compression	
* Osteophytes
Investigation	
* C-spine x-ray - osteophytes	
* MRI - canal stenosis, cord anomalies
Treatment	
* Depends on cause	
* Conservative: physio	
* Surgery for pain and progressive sx
28
Q

Radiculopathy: signs, symptoms, causes, investigations, treatment

A 
SciaticaSigns	
* Leg pain	
* Radiates below ankle	
* Positive SLR
Symptoms	
* sharp + shooting (worse w/ cough/sneeze)	
* altered sensation	
* reduced power corresponding myotone	
* absent/reduced reflexes	
* later muscle wasting/fasiculations
Causes	
* Prolapsed Intervertebral disc	
* Spinal stenosis	
* Cauda equina syndrome	
* Facet arthrosis
Investigations	Differentiate referred pain from nerve root pain			Referred pain					
* Dull Poorly localised			
* may affect both legs						nerve root pain					
* sharp well localised			
* closely follows dermatone			
* paraesthesia may be present			
* positive SLR						
Treatments	
* Physiotherapy and education	
* Nerve root block	
* Epidural steroid injection	
* Foraminal steroid injection	
* Surgical decompression
29
Q

What is the difference between myelopathy and radiculopathy

A

Myelopathy - compression of spinal cordRadiculopathy - compression of nerve root

30
Q

Define:Osteophytes, spondylosis, spondylolysis and spondylolisthesis

A

osteophytes -bony projection associated with the degeneration of cartilage at jointsspondylosis - umbrella term for spine degenerationspondylolysis - stress fracture inpars interarticularis (pointy bit of vertebrae)spondylolisthesis - Slippage of vertebrae from stress facture above

31
Q

what is the difference betweenbulbar and pseudobulbar palsy

A

bulbar palsyis a lower motor neuron lesion of cranial nerves 9, 10and 12. Apseudobulbar palsyis an upper motor neuron lesion of cranial nerves 9, 10and 12

CP3 Knowledge Resits (12 decks)

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